Do improvements in motivational language predict alcohol use in motivational interviewing? Ambivalence matters.

Objective: Motivational Interviewing (MI) is described as a method for improving clinical outcomes by reducing client ambivalence. If this is true, MI's focus on improving clients' motivational language should be most useful for clients with ambivalence about change and less valuable for those who are ready to implement new behaviors or are opposed to change. To address this hypothesis and potentially add precision to MI delivery in clinical settings, we tested whether the relationship between clients' in-session motivational language and posttreatment alcohol use depended on their baseline motivation to change.

Mental Health Counseling From Conversational Content With Transformer-Based Machine Learning.

Importance: Use of asynchronous text-based counseling is rapidly growing as an easy-to-access approach to behavioral health care. Similar to in-person treatment, it is challenging to reliably assess as measures of process and content do not scale.

Objective: To use machine learning to evaluate clinical content and client-reported outcomes in a large sample of text-based counseling episodes of care.

Effectiveness and feasibility of a motivational interviewing intake (MII) intervention for increasing client engagement in outpatient addiction treatment: an effectiveness-implementation hybrid design protocol.

Background: Client discontinuation from outpatient addiction treatment programs is common, and the initial intake is the service delivery point with the highest attrition rate. Replacing the comprehensive intake assessment with a person-centered Motivational Interviewing (MI) intervention is a potential solution to address provider and client concerns about the disengaging, time-intensive nature of the typical initial intake. It remains unclear whether the use of an alternative to the standard intake at the initial visit can fit within typical organizational reporting requirements, whether it decreases attrition, and whether implementation of person-centered intake procedures within outpatient addiction treatment programs is feasible, acceptable, and can be sustained.

What can clients tell us about whether to use motivational interviewing? An analysis of early-session ambivalent language.

Background: Although motivational interviewing (MI) is an effective method for promoting change in problematic alcohol and other drug use, it does not benefit all clients. Clinicians have little empirical guidance on who is likely to benefit from MI and who is not. We hypothesized that differences in clients' spontaneously offered language early in the session would predict their responsiveness to MI during the remainder of the session.

Should Substance Use Counselors Choose a Direction For Their Clients? Motivational Interviewing Trainers May Be Ambivalent.

Motivational Interviewing (MI) is comprised of a client-centered relationship and a clear intention on the part of the practitioner to influence behavior change. This study explores MI trainers' decisions about their use of directionality in MI as they instruct others in the method. 111 MI trainers were asked to select content they would include in a hypothetical MI training.

Can a pure motivational interviewing intervention be manualized and still efficacious? A test of feasibility and initial efficacy.

The importance of attending to the therapeutic process despite the challenges in manualizing it is demonstrated in the empirical evolution of motivational interviewing (MI). Whereas manuals exist for adaptations of MI, no manual has been developed and tested for MI in its pure form (pure MI). This study evaluated the feasibility and initial efficacy of a pure MI intervention manual - MI for risky social drinking (MI-RSD) - designed to target risky social drinking behaviors in college students with social anxiety.

Mechanisms of Motivational Interviewing: a Conceptual Framework to Guide Practice and Research.

Reviews of the motivational interviewing (MI) training literature demonstrate MI is a nuanced skill set that takes carefully planned didactic training, application of skills in context-specific practice settings, and ongoing support to promote reflective practice and sustained proficiency. Despite the robust knowledge base related to training and how MI works to achieve favorable outcomes, these two literature bases are not well integrated. In an effort to inform and guide future research, we propose the mechanisms of motivational interviewing (MMI) conceptual framework, which expands upon previous work.

Is fidelity to motivational interviewing associated with alcohol outcomes in treatment-seeking 60+ year-old citizens?

Background: Part of the variability in treatment outcomes for Motivational Interviewing (MI) may be explained by differences in the fidelity to MI. The Motivational Interviewing Treatment Integrity manual version 4 (MITI 4) is an improved measure of fidelity to elements of MI. It is not known whether the fidelity to MI, as measured by the MITI 4, is related to treatment outcome.

With odds of a single session, motivational interviewing is a good bet.

First sessions of psychotherapy present a rare and potent opportunity for therapists and clients alike. Motivational interviewing is established as a stand-alone method for promoting behavior change as well as a useful prelude to other therapies. This article provides a rationale and empirical support for the use of motivational interviewing in first psychotherapy sessions.

Lessons learned from measuring fidelity with the Motivational Interviewing Treatment Integrity code (MITI 4).

Background And Aims: The Motivational Interviewing Treatment Integrity code (MITI) measures fidelity to, and the quality of, Motivational Interviewing (MI), and can also be used when MI is combined with other treatment methods. The current study presents a fidelity measurement with the MITI 4.2.

Examining the influence of active ingredients of motivational interviewing on client change talk.

Motivational Interviewing (MI) is an evidenced-based intervention designed to help clients explore and resolve ambivalence around substance use. MI combines a humanistic tradition with behavioral components to facilitate client decisions concerning behavior change. As such, there is marked interest in the relationship between the two active ingredients of MI - the relational, or person-centered, components and the technical, or directional, behavioral components - on client in-session language.

Short- and Long-Term Effects of Within-Session Client Speech on Drinking Outcomes in the COMBINE Study.

Objective: There is evidence of a causal chain in motivational interviewing (MI) involving counselor MI-consistent skills, client change language, and outcomes. MI was a key component of the combined behavioral intervention in the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study. Participants in COMBINE were treatment-seeking and medication-seeking, and were required to maintain a period of abstinence before enrollment.

Motivational interviewing and the clinical science of Carl Rogers.

The clinical method of motivational interviewing (MI) evolved from the person-centered approach of Carl Rogers, maintaining his pioneering commitment to the scientific study of therapeutic processes and outcomes. The development of MI pertains to all 3 of the 125th anniversary themes explored in this special issue. Applications of MI have spread far beyond clinical psychology into fields including health care, rehabilitation, public health, social work, dentistry, corrections, coaching, and education, directly impacting the lives of many people.

A randomized controlled trial to influence client language in substance use disorder treatment.

Background: Client language is hypothesized to be a mechanism of action in motivational interviewing (MI). Despite the association of change and sustain talk with substance treatment outcomes, it not known whether providers can intentionally influence this language as hypothesized.

Objective: This is a randomized controlled trial to investigate whether substance use providers can be trained to influence client language.

The Motivational Interviewing Treatment Integrity Code (MITI 4): Rationale, Preliminary Reliability and Validity.

Unlabelled: The Motivational Interviewing Treatment Integrity code has been revised to address new evidence-based elements of motivational interviewing (MI). This new version (MITI 4) includes new global ratings to assess clinician's attention to client language, increased rigor in assessing autonomy support and client choice, and items to evaluate the use of persuasion when giving information and advice.

Method: Four undergraduate, non-professional raters were trained in the MITI and used it to review 50 audiotapes of clinicians conducting MI in actual treatments sessions.

Therapist empathy, combined behavioral intervention, and alcohol outcomes in the COMBINE research project.

Objective: Common factors such as therapist empathy play an important role in treatment for addictive behaviors. The present study was a secondary analysis designed to evaluate the relation between therapist empathy and alcohol treatment outcomes in data from a large, multisite, randomized controlled trial.

Method: Audio-recorded psychotherapy sessions for 38 therapists and 700 clients had been randomly selected for fidelity coding from the combined behavioral intervention condition of Project COMBINE.

Within-session communication patterns predict alcohol treatment outcomes.

Background: Within-session client speech is theorized to be a key mechanism of behavior change in motivational interviewing (MI), a directional, client-centered approach to behavior change. Client change talk (CT: speech indicating movement toward changing a problematic health behavior) and sustain talk (ST: speech supporting continuing a problematic health behavior) have each shown relationships with outcomes. However, it may be the case that patterns of within-session client speech, rather than counts of client speech, are important for producing change.

Outpatient treatment of alcohol use disorders among subjects 60+ years: design of a randomized clinical trial conducted in three countries (Elderly Study).

Background: The proportion of 60+ years with excessive alcohol intake varies in western countries between 6-16 % among men and 2-7 % among women. Specific events related to aging (e.g.

The relationship in motivational interviewing.

The therapeutic relationship in motivational interviewing is hypothesized to have both a direct impact on client outcomes as well as facilitating the emergence of client language in favor of change. The nature of this relationship is characterized by empathy, partnership, and support of the client's autonomy commonly called the spirit of the method. This article explores the implications of this spirit on the practice and understanding of motivational interviewing, including common misconceptions attributable to a misunderstanding of the role of the relationship.

The forest and the trees: relational and specific factors in addiction treatment.

Aims: Increased expectations for the use of evidence-based methods in addiction treatment have fueled a debate regarding the relative importance of 'specific' versus 'common' factors in treatment outcome. This review explores the influence of these factors on addiction treatment outcome.

Methods: The authors review and link findings from four decades of research on specific and general factors in addiction treatment outcome research.

Bidirectional relationships between client and counselor speech: the importance of reframing.

In the study of motivational interviewing (MI), counselor skill has been posited to influence client language about change or "change talk." This study investigates the relationship between a specific counselor behavior, valenced reflective listening, and client change talk in a MI intervention with substance-using adolescents. A combination of recorded in-person and telephone (n = 223) sessions were sequentially coded using the Motivational Interviewing Skill Code 2.

From counselor skill to decreased marijuana use: does change talk matter?

Client language about change, or change talk, is hypothesized to mediate the relationship between counselor fidelity in motivational interviewing (MI) and drug use outcomes. To investigate this causal chain, this study used data from an MI booster delivered to alternative high school students immediately after a universal classroom-based drug abuse prevention program. One hundred and seventy audio-recorded MI sessions about substance use were coded using the motivational interviewing skill code 2.